Applicant Initials __________

APPLICATION FOR FINANCING • Please refer to the checklist for the supporting documents that accompany the application.

• The $75 non-refundable fee can be paid online at WEC.ca/LoanAppFee

• If you are offering a co-applicant, please have her or him fill out this application as well.

• Please complete the entire application in full. If a field does not apply, enter “N/A”.

• Completed applications can be e-mailed to loans@womensenterprise.ca or mailed to our head office address: #201 – 1726 Dolphin Avenue Kelowna, BC V1Y 9R9.

APPLICANT INFORMATION

Last Name First Name Middle Name

Social insurance number Date Of Birth (mm/dd/yy)

/ /

No. Of Dependants Marital Status Married Single Separated Common-Law Widowed Divorced

Citizenship Canadian Other Permanent Resident

How did you find out about our lending program?

We want to make sure we are serving all women, regardless of ethnicity. Please indicate if you are: Aboriginal Immigrant

Home address City Postal Code Years at this address Status

Rent Own Other-Specify Mortgage holder or landlord name and telephone

Monthly payment

$

Outstanding balance of mortgage

$ Previous address if less than 3 years at current

Postal Code

Years at previous address

Tel: Home Cell Work Tel: Home Cell Work Personal e-mail address

For loans under $50,000: Are you applying for an unsecured loan? If so, are you applying under one of the following Equal Access to Capital Loan categories:

Aboriginal Youth under 40 Immigrant within 5 years of Permanent Residency General

EMPLOYMENT INFORMATION (Indicate if Self-Employed )

Current or Last employer Telephone number

Position Monthly income $

Years

Previous employer if less than 3 years Telephone number

Position Monthly income $

Years

REFERENCES (Please list two business references that can attest to your business skills and one family contact)

Name

Business/Employer Name Telephone Number Relationship

Name

Business/Employer Name Telephone Number Relationship

Name (Family Member not living at the same address)

Business/Employer Name Telephone Number Relationship

Page | 2 Applicant Initials __________

PERSONAL BANKING & CREDIT

Have you ever filed for personal bankruptcy? No Yes

If yes, please describe and provide dates

Have you guaranteed the loans or financial commitments of others? No Yes

If yes, please describe and provide dates

Have you been a principal guarantor of a business that has filed bankruptcy or defaulted on any debts?

No Yes If yes, please describe and provide dates

Are you party as debtor/defendant to any claim or lawsuit? No Yes

If yes, please describe and provide dates

Do you have any outstanding accounts with Canada Revenue Agency (CRA)? No Yes

If yes,

GST/PST Payroll deductions Other

$ $ $

BUSINESS INFORMATION (Existing or Proposed)

Legal name of business Home Based or

Commercially Based

Business Start Date

Business address City Postal Code Telephone number Fax number

Cell phone E-mail address Website address

Structure Incorporated – you must provide a copy of Incorporation Certificate Sole proprietorship Partnership Other-specify

Business Number (9 digits long) Fiscal Year End

Business financial institution name and branch Account number Type of account(s)

EQUITY CONTRIBUTION

Name of shareholder Role/function Ownership

%

Equity contributed

$

Full-time

Part-time Name of shareholder Role/function Ownership

%

Equity contributed

$

Full-time

Part-time Name of shareholder Role/function Ownership

%

Equity contributed

$

Full-time

Part-time Number of current employees ____ Seasonal ____ Part-time _____ Full-time

Estimated number of new jobs to be created ____ Part-time ____ Full-time When will they be created?

Do you have additional equity to contribute? $ Specify:

Economic benefit business would/does provide to British Columbia:

Page | 3 Applicant Initials __________

BUSINESS HISTORY

Do environmental factors or regulations impact this business? No Yes If yes, please describe

Has this business ever filed for bankruptcy? No Yes If yes, please describe and provide dates

Is this business a party to any claim or lawsuit? No Yes

If yes, please describe and provide dates

Has this business guaranteed the loans or financial commitments of others? No Yes

If yes, please describe and provide dates

LOAN REQUEST DETAILS Total Funds Requested: $ Breakdown of total funds requested

Start up Expansion Purchase of an existing business Other-specify

Needed for operating/capital $

Needed for vehicle(s) $

Needed for equipment $

Needed for leaseholds $

Needed for inventory $

Needed for other (specify) $

Please describe specifics of what funds will purchase

Is this a joint loan with another lender? Yes No If yes, list below with who?

Lender Name

Approved Declined In process Amount approved

$

Lender Name

Approved Declined In process Amount approved

$

Aside from joint financing, are you currently applying with any other lenders? Yes No If Yes, indicate who?

If you have been declined by another lender, please state reason

If you have any outstanding loans, please state security you have pledged

If you have not sought funding elsewhere, please state reason

Do you have a co-signer available? Yes No Please have your co-applicant complete one of the application forms.

Security Item 1 Item 2 Item 3

Asset to be offered as security – please describe

Serial Number or VIN

Description (eg: convertible, leather seats, air-cond, model)

Existing Liens? No Yes No Yes No Yes

Is the security being offered in your possession now? No Yes No Yes No Yes

Is the security 100% owned by you? No Yes No Yes No Yes

Plan to purchase with the loan requested, then offer for security? No Yes No Yes No Yes

If the security offered is in the form of property, you must provide a copy of the latest property assessment AND a current mortgage statement that details the balance of your mortgage.

You must provide registration copies for any vehicle/boat/trailer offered for security with this application.

Page | 4 Applicant Initials __________

HOUSEHOLD INCOME STATEMENT (Please include your spouse/common-law partner here.)

Assets

Liabilities

Balances Balances

DEPOSITS AND INVESTMENTS LOANS AND MORTGAGES

Chequing Accounts $ First Mortgage $

Savings Accounts $ Second Mortgage $

GIC’s / Term Deposits $ Student Loans $

Mutual Funds $ Vehicle Loans $

RRSP $ Other: $

Other: $ Other: $

Other: $ SUB TOTAL $

SUB TOTAL $ CREDIT ACCOUNTS

REAL ESTATE Credit Cards $

Home $ Department Stores $

Recreational Property $ Other: $

Other: $ Other: $

SUB TOTAL $ SUB TOTAL $

OTHER ASSETS OTHER LIABILITIES

Cars $ Guarantees $

RV, Boat $ Family, Friends $

Other: $ Other: $

Other: $ Other: $

SUB TOTAL $ SUB TOTAL $

TOTAL ASSETS $ TOTAL LIABILITIES $

ESTIMATED TOTAL NET WORTH (Total Assets minus Total Liabilities) = $

MONTHLY INCOME MONTHLY EXPENSES

Your Net Income (after tax) $ Mortgage/Rent $

Spousal Net Income $ Food $

Pensions, Annuities $ Utilities $

Investments $ (gas, insurance etc)Transportation $

Support Payments $ Recreation/Hobbies $

Other Personal Income $ Insurance $

Other: $ Medical $

Other: $ Education/Child Care $

Other: $ Total Loan Payments $

Other: $ Credit Cards Payments $

Other: $ Entertainment $

Other: $ Other: $

Other: $ Other: $

TOTAL INCOME $ TOTAL EXPENSES $

TOTAL NET INCOME (Total Income minus Total Expenses) = $

I certify that by signing this application the information given on this Household Income Statement is complete, correct and fully discloses all my assets, liabilities and income.

Page | 5 Applicant Initials __________

CONSENT TO OBTAIN AND USE INFORMATION

I/we consent to Women’s Enterprise Centre making any credit and general inquiries necessary to make a lending decision. In the case that this application is approved, I also consent to any inquiries necessary for the ongoing maintenance of the account. I consent to the disclosure at any time of any credit information about me to any credit reporting agency or anyone with whom I have financial relations.

I/we authorize Women’s Enterprise Centre to disclose at any time, in response to direct inquiries from any other lender, or credit bureau, any information concerning me/us that Women’s Enterprise Centre considers appropriate.

I/we consent to the exchange of information with other financial institutions or financial partners having an interest in the application.

In the case that this application is declined, Women’s Enterprise Centre will keep my/our personal information on file to inform me/us of the Women’s Enterprise Centre products and services from time to time.

I/we consent to being contacted by or my information being used by Women’s Enterprise Centre. I also consent to being contacted from time to time by other outside organizations that provide information to the Government or that research topics related to women in business and/or to Women’s Enterprise Centre providing my contact information to said organizations.

I/we declare that the statements made by myself herein are for the purpose of obtaining financing and are to the best of my knowledge true and correct.

Page | 6 Applicant Initials __________

ACKNOWLEDGEMENT AND RELEASE

I/we acknowledge that Women’s Enterprise Centre, its directors, representatives and employees are not providing me/us with ‘professional financial or legal advice’ and have not held themselves out to me to be an expert in any particular field, but rather to be a source or information, support and encouragement for women in business.

I/we hereby release Women’s Enterprise Centre, its directors, representatives and employees from responsibility should I choose to rely on the information and advice provided to me by or on behalf of Women’s Enterprise Centre.

I/we acknowledge that Women’s Enterprise Centre has advised me to seek professional financial and legal advice when appropriate and to conduct my own investigations into all matters pertaining to my business. Women’s Enterprise Centre has advised me not to rely solely on the information and advice given to me by or on behalf of Women’s Enterprise Centre.

By applying for this loan, I acknowledge that I have been made aware of and have explored other financial options.

By my signature below I warrant that I have read and understand this document and I sign on behalf of myself and any company or partnership I represent.

Please note you will be automatically added onto Women’s Enterprise Centre e-mail list. If you do not want to be on this list, please let your Business Advisor know.

Signature of Applicant

Applicant Print Name

Date

Please retain a copy of your business plan and this application for your files.

Please e-mail or mail your application(s) and supporting documents to the address below:

E-mail: loans@womensenterprise.ca

Women’s Enterprise Centre #201 – 1726 Dolphin Avenue Kelowna, BC V1Y 9R9 Tel: 250.868.3454 Toll-Free: 1.800.643.7014 Fax: 250.868.2709